Surface Warfare Medicine Institute

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Surface Warfare Medicine Institute

This booklet is designed to be useful to senior medical officers filling billets for CATF Surgeons and Officers-in-Charge of Fleet Surgical Teams. The information herein is derived from primary sources that are usually identified within the text. Non-referenced information is included in order to tap the experience of previous CATF Surgeons, and is so identified.

Please send all correspondence concerning the content and style of this booklet to CAPT Jeffrey M. Young, MC, USNR, editor of the FMPR 1999, at the address below. All feedback is useful, and updates are scheduled for release annually.

Surface Warfare Medicine Institute

Building 500, Room 114

140 Sylvester Road

Naval Submarine Base

San Diego CA 92106-3521

(619) 553-0097


Table of Contents
Acronyms and Abbreviations 5

Bibliography 11

Blood Program 14

BUMED-14 Message 23

Casualty Receiving and Treatment Ships 24

CATF Surgeon Tasks 30

CLF Surgeon Tasks 32

Communications 33

Crisis Management 36

Echelons of Care 37

Fleet Surgical Teams 40

Glossary 45

Liberty & Working Port Visits 61

Mass Casualties 63


Medical Intelligence 65

Message Writing 72


M+1 CRTS Wartime Manning 77

Post-deployment Critiques 79

Pre-deployment Checklist (BUMED) 83

Pre-deployment Checklist (PHIBGRU 3) 85

Preventive Medicine 89

Quality Assurance/Credentials 94

Ship’s Compartment Numbering 97

Shipboard Protocols 98

Shipboard Resources Guide 100

Shipboard Terminology 102

Triage 103

Victims & Perpetrators & Alcohol Misuse 113

WWW & Telephone List 114

The following individuals were instrumental in the development of this reference. Their assistance has been invaluable and deeply appreciated.
CAPT John Fahey, MC, USN

CAPT Konrad Hayashi, MC, USN

CAPT Steve Nichols, MC, USN

CAPT T.G. Patel, MC, USN, Ret.

CAPT Terrence Riley, MC, USN

CAPT Adam Robinson, MC, USN

CAPT David Snyder, MC, USN

CAPT Michael Valdez, MC, USN

CAPT Jeffrey M. Young, MC, USNR

CDR Sue Herrold, NC, USN

CDR Doug McMullen, MC, USN

CDR Ken Schor, MC, USN

CDR Dave Taft, MC, USN

LCDR Dennis Moses, MSC, USN, Ret.

LCDR Eric Rasmussen, MC, USN

LCDR Sally Veasey, MSC, USN

LT Youssef H. Aboul-Enein, MSC, USNR

LT William Hatley, MSC, USN

LT Bruce Thompson, MSC, USN

Mr. Jeffrey Stiech, BUMED-14


(NWP3, NWP4-02, JCS Pub 1, edited superset)

Composite Warfare Commanders

(Amphibious Ready Groups use an “L” designation instead of the leading “A”)

AA Officer in Tactical Command

AB Composite Warfare Commander

AQ Command and Control Warfare Commander

AW Anti-Air Warfare Commander

AS Anti-Surface Warfare Commander

AX Anti-Submarine Warfare Commander

AP Strike Warfare Commander

AR Air Resource Commander

Alphabetical Listing

AAA arrival and assembly area

AAAV advanced amphibious assault vehicle

AABB American Association of Blood Banks

ABFC advance base functional components

ACE Air Combat Element

ACLS advanced cardiac life support

ACU Assault Craft Unit

ADAL Authorized Dental Allowance List

AECC aeromedical evacuation coordination center

AELT aeromedical evacuation liaison team

AFMIC Armed Forces Medical Intelligence Center

AJBPO area joint blood program office

ALCC airlift control center

AMMAL Authorized Minimum Medical Allowance List

AO area of operation; or Air Officer

AOR area of responsibility

AP armor-piercing

ARG Amphibious Readiness Group

ASBBC Armed Services Blood Bank Center

ASBP Armed Services Blood Program

ASD (HA) Assistant Secretary of Defense (Health Affairs)

ASF aeromedical staging facility

ASMRO Armed Services Medical Regulating Office

ASWBPL Armed Services Whole Blood Processing Laboratory

ATF Amphibious Task Force

ATLS advanced trauma life support

ATO air tasking order


BAS battalion aid station

BB blood bank

BDA battle damage assessment

BES beach evacuation station

BDC blood donor center

BLDRPT blood report

Blood Program acronyms: see Blood Program chapter

BLS basic life support

BPD blood product depot

BSU Blood Supply Unit

BTC blood transshipment center

C2 command and control

C2W command and control warfare

C4I command, control, communication, computer & intelligence

CAS close air support

CAT Crisis Action Team

CATF Commander, Amphibious Task Force

CBR chemical, biological, and radiological

CBTZ combat zone

CCO Combat Cargo Officer

CE combat element

CECO Combat Evacuation Control Officer

CI counter-intelligence

CIA Central Intelligence Agency

CIC Combat Information Center

CIFS close-in fire support

CINC Commander in Chief

CLF Commander, Landing Force

CLZ LCAC landing zone

CLZA LCAC landing zone support area

CME continuing medical education

CNO Chief of Naval Operations

COC combat operations center

COMMZ communications zone

CONREP connected replenishment

COMSEC communications security

CONUS continental United States

CP command post

CPG Commander, Amphibious Group (ONE, TWO, or THREE)

CPR cardiopulmonary resuscitation

CRRC combat rubber raiding craft

CRTF casualty receiving and treatment facility

CRTS casualty receiving and treatment ship

CSAR combat search and rescue

CSO Chief Staff Officer (of amphibious squadron – PHIBRON)

CSS combat service support

CSSD Combat Service Support Detachment

CSSE combat service support element

CTF Commander, Task Force

DAS deep air support

DASC Direct Air Support Center

DET detachment

DEW directed energy weapon (usually laser)

DFAS Defense Finance & Accounting Service

DIA Defense Intelligence Agency

DNBI disease and nonbattle injury

DOD Department of Defense

DOS day of supply

DOS Department of State (State Department)

DOWW disease occurrence worldwide

DRAW demonstration, raid, assault, withdrawal (amphib ops)

DTF Dental Treatment Facility

DTG date-time group (messages)

DZ drop zone


EAF expeditionary airfield

EEI essential elements of information

ELINT electronic intelligence

EMB embarkation

EMCON emission control

EMT emergency medical technician

EPW enemy prisoner of war

EW electronic warfare


FAC forward air controller

FCC Federal Coordinating Center

FCSSA force combat service support area

FDC fire-direction center

FEBA forward edge of the battle area

FEMA Federal Emergency Management Agency

FFA free-fire area

FFP fresh frozen plasma

FIC Fleet Intelligence Center

FISC Fleet and Industrial Supply Center

FLTCINC Fleet Commander in Chief

FMF Fleet Marine Force

FO forward observer

FOD foreign object damage

FORSCOM Forces Command

FOS full operating status

FP frozen platelets; or Family Practice

FRBC frozen red blood cells

FSCC Fire-Support Coordination Center

FSSG Force Service Support Group

FST Fleet Surgical Team


GCE ground combat element (MAGTF)

GPMRC Global Patient Movement Requirements Center

GPS global positioning system

GQ general quarters

GYN gynecology


H&S Headquarters and Service Company

HANDSCO Headquarters and Service Company

HCS Helicopter Coordination Section

HDC Helicopter Direction Center

HE high explosive

HHS health service support

HLSC Helicopter Logistics Support Center

HNS host-nation support

HSS helicopter service support

HST Helicopter Support Team

HUMINT human intelligence (vs. satellite imagery, radio signal, etc.)


IADS Integrated Air Defense System

IAW in accordance with

IDC independent duty hospital corpsman

IDTC inter-deployment training cycle

IFF identification, friend or foe

IMA individual mobilization augmentee

IP initial point

IRR Individual Ready Reserve

ISO International Standardization Organization

ISIC immediate superior in command

ITT Interrogator and Translator Team

IV intravenous

JBPO Joint Blood Program Office

JCS Joint Chiefs of Staff

JDS Joint Deployment System

JIC Joint Intelligence Center

JMBO Joint Military Blood Office

JMRO Joint Medical Regulating Office

JOPES Joint Operations Planning and Execution System

JORG junior officer requiring guidance (found on collar device)

JTF Joint Task Force

JULL Joint Unified Lessons Learned

KIA killed in action


LANTFLT Atlantic Fleet

LCAC landing craft, air cushion (assault hovercraft)

LF Landing Force

LFOC Landing Force Operations Center

LFSP landing force support party

LOC line of communication

LOD line of departure

LOI letter of instruction

LZ landing zone

LZCP landing zone control party

LZSA landing zone support area


MAGTF Marine Air-Ground Task Force

MANMED Manual of the Medical Department

MAO master-at-arms

MAO Medical Administrative Officer

MAP medical augmentation program

MARDIV Marine division

MARG Marine Amphibious Readiness Group

MASF Mobile Aeromedical Staging Facility

MCLL Marine Corps Lessons Learned

M-Day mobilization day

MEDCAPS medical capabilities study

MEDEVAC medical evacuation

MEF Marine Expeditionary Force

MEF (FWD) Marine Expeditionary Force (forward)

MEPES medical planning and execution system

MEU Marine Expeditionary Unit

MIA missing in action

MMART Mobile Medical Augmentation Readiness Team

MOPP mission-oriented protective posture

MPF Maritime Pre-Positioning Force

MRCC Medical Regulating Control Center

MRCO Medical Regulating Control Officer

MRS medical regulating system

MSC Military Sealift Command; or major subordinate command

MSOC Medical Support Operations Center

MSR main supply route

MTF Medical Treatment Facility

MWR Morale, Welfare, and Recreation

NATO North Atlantic Treaty Organization

NATOPS naval air training and operating procedures

NBC nuclear, biological, and chemical

NBG naval beach group

NCA National Command Authority

NDMS National Disaster Medical System

NEO non-combatant evacuation operation

NGO non-governmental organization

NOFORN not releasable to foreign nationals

NOTAM notice to airmen

NSA National Security Agency

NSN national stock number

NWP Naval Warfare Publications


O&M operation and maintenance

OAS offensive air support

OBJ objective

OCONUS outside continental United States

OIC Officer-In-Charge

OMFTS operational maneuvers from the sea

OOTW operations other than war

OPCON operational control

OPLAN operational plan

OPNAV Office of the Chief of Naval Operations

OPNAVINST Naval Operations Instruction

OPLAN operations plan

OPORD operations order

OPSEC operations security

OPSUM operational summary (a daily report)

OPTEMPO intensity of operations (e.g., low, high, extreme)

OSC On-Scene Commander

OTC Officer in Tactical Command

OTH over-the-horizon


PACFLT Pacific Fleet

PAHO Pan American Health Organization

PCO primary control officer

PCRTS primary casualty receiving and treatment ship

PCS primary control ship

PIM position of intended movement

PMI patient movement item

POE projected operational environment

POL petroleum, oil, and lubricants

POM program objective memorandum

POM pre-overseas movement (as in POM period)

POMI Plans, Operations, and Medical Intelligence Officer


QR quick reaction


RAS regimental aid station

RBC red blood cells

RCA riot-control agent

RLT Regimental Landing Team

ROC required operational capability

ROE rules of engagement

ROPU reverse osmosis processing unit

RORO roll on - roll off

ROS reduced operating status


SAM surface-to-air missile

SAR search-and-rescue

SATCOM satellite communications

SCM ship’s cargo manifest

SEAL sea-air-land

SERE survival, evasion, resistance, escape

SIGINT signal intelligence

SLOC sea lines of communication

SOP standard operating procedure

SORM Standard Organization and Regulations Manual of the US Navy (OPNAV 3120.32 series)

SORTS status of readiness and training

SPLT shore party liaison team

SPECAT special category

STANAG standardization agreement

STP Shock-trauma Platoon

SURGCO Surgical Company

T-AH hospital ship

TAML theater area (or Army) medical lab

T/O table of organization

TAC Tactical Air Commander

TACAN tactical air navigation system

TACC Tactical Air Control Center

TACLOG Tactical-Logistical Group

TACRON Tactical Air Control Squadron

TAD Tactical Air Director

TADC Tactical Air Direction Center

TAO Tactical Air Observer

TAOC Tactical Air Operations Center

TAR tactical air request (net circuit)

TEWA threat evaluation and weapons assignment

TF Task Force

TFMRS task force medical regulating system

TOC Tactical Operations Center

TOW tube-launched, optically-tracked, wire-guided (missile)

TPFDD time-phased force and deployment data

TPMRC Theater Patient Movement Requirements Center

TRAC2ES TRANSCOM's regulating command and control evacuation system

TRANSCOM Transportation Command

TRAP tactical recovery of aircraft and personnel

TYCOM Type Command

UDT Underwater Demolition Team

UNREP underway replenishment

USACOM United States Atlantic Command

USAF United States Air Force

VERTREP vertical replenishment

V/STOL vertical/short take-off and landing

WB whole blood

WIA wounded in action

WHO World Health Organization

WMCCS worldwide military and command control system

The following publications/references are for use in planning and delivery of fleet medical support. Most of these are directly referred to in NWP4.02, Operational Medical and Dental Support. Those with a double asterisk (**) have associated Medical Correspondence Courses available through the Naval School of Health Sciences, Portsmouth (


The Joint Staff Officer's Guide

BUMED INST 3400.1 Series

Operational Concept for Medical Support and Casualty Management in Chemical and Biological Warfare Environments

BUMED INST 5360.1 Series ** (NAVEDTRA 13154)

Decedent Affairs

BUMED INST 5430.6 Series

BUMED Organization Manual

BUMED INST 6200 Series ** (NAVEDTRA 13112)

General Information on Preventive Medicine

BUMED INST 6300.2 Series

Medical Services and Outpatient Morbidity Reporting System

BUMED INST 6320.1 Series ** (NAVEDTRA 13113)

Medical Regulating To and Within the Continental United States

BUMED INST 6440.5 Series

Medical Augmentation Program

BUMED INST 6470.10

Initial Management of Irradiated or Radioactively Contaminated Personnel

BUMED INST 6700.13 Series

Authorized Medical / Dental Allowance List for U.S. Naval Vessels, Fleet Marine Force, and Other Elements of the Operating Forces

BUMED INST 6700.36 Series

Medical and Dental Equipment Maintenance and Repair Manual


Mobile Medical Augmentation Readiness Team (MMART) Supply Block

DA Pamphlet 27-1

Treaties Governing Land Warfare (Geneva Conventions)

Defense Intelligence Agency Manual (DIA M) 59-1

Users Guide to Intelligence Dissemination / Reference Services

DOD 6420.1 Series

Organizational Functions of the Armed Forces Medical Intelligence Center

DOD 6480.4 Series

DOD Blood Program: Mobilization Planning Factors

FMFM 1-8 / NWP 3-02.1

Ship to Shore Movement


Combat Service Support

FMFM 4-50

Medical and Dental Support, U.S. Marine Corps

FMFRP 0-14

Marine Corps Supplement to DOD Dictionary of Military and Associated Terms

Joint Pub 1-02

DOD Dictionary of Military and Associated Terms

Joint Pub 3-02

Joint Doctrine for Amphibious Operations

Joint Pub 4-02

Doctrine for HSS in Joint Operations

Joint Pub 4-02.1

JTTP for Health Service Logistics Support in Joint Operations

Joint Pub 4-02.2

JTTP for Patient Evacuation in Joint Operations

JOPES Volume I

Joint Operations Planning and Execution System, Medical Planning and Execution System (MEPES; formerly JOPS)

JOPS Volume I

Joint Operation Planning System, Volume I (Deliberate Planning Procedures)


Joint Operation Planning System, Volume III (ADP Support), Appendix U (Medical Planning Module (MPM)

LFM 01 / NWP 22 / FM 31-11 / AFM 2-53

Doctrine for Amphibious Operations

MCO 6700.2 Series

Medical and Dental (Class VIII) Materiel for Support of the Fleet Marine Force

NAVMAT P-4000-2

Logistic Reference Data

NAVMED P-117 (Available on Virtual Naval Hospital (VNH) website and VNH CD)

Manual of the Medical Department (MANMED)


Preventive Medicine Manual


The Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries


Medical Support in Joint Operations (1972)


Occupational and Environmental Health Prevention Treatment and Control of Heat Injury


The Radiation Health Protection Manual


Joint Blood Program Handbook, (ASBPO). January 1998


Bureau of Medicine and Surgery

NAVMEDCOM INST 6321.1 Series

Bed Capacity and Licensed Beds

NDP 1 ** (NAVEDTRA 13158)

Naval Warfare

NDP 2 ** (NAVEDTRA 13159)

Naval Intelligence

NDP 4 ** (NAVEDTRA 13158)

Naval Logistics

NWP 5 ** (NAVEDTRA 13160)

Naval Planning

NWP 6 ** (NAVEDTRA 13161)

Naval Command and Control

NWP 1-01

Naval Warfare Publication System

NWP 1-02

Naval Supplement to the DoD Dictionary of Military and Associated Terms

NWP 3-02.1 (Formerly NWP 22-3) / FMFM 1-8

Ship to Shore Movement

NWP 4-02 ** (NAVEDTRA 13158)

Operational Health Service Support

NWP 4-02.1 ** (NAVEDTRA 13158)

Health Service Support Logistics

NWP 4-02.2

Patient Movement, Part A: Naval Expeditionary Forces Medical Regulating

NWP 4-02.3

Planning, Operations, and Medical Intelligence, Part B: Medical Intelligence

NWP 4-02.3

Planning, Operations, and Medical Intelligence, Part D: Operations Other than War

NWP 4-02.4 ** (NAVEDTRA 13158)

Deployable HSS Platforms, Part A: Fleet Hospitals

NWP 4-02.4

Deployable HSS Platforms, Part B: Hospital Ships (T-AH)

NWP 4-02.4

Deployable HSS Platforms, Part C: Forward Deployable Laboratory

NWP 4-02.6

Clinical Specific HSS, Part C: Women's HSS in Operational Settings

NWP 4-02.7

Occupational and Environmental Health Services Support

NWP 11

Naval Operational Planning

NWP 11-3

Characteristics and Capabilities of U.S. Navy Aircraft

NWP 22-3 (Now NWP 3-02.1)

Ship to Shore Movement (see also FMFM 1-8)

NWP 65-0-1

Characteristics and Capabilities of U.S. Navy Combatant Ships

OPNAV INST 1000.16 Series

Manual of Navy Total Force Manpower

OPNAV INST S 3061.1 Series

The Navy Capabilities and Mobilization Plan

OPNAV INST 3061.2 Series

Total Force Manpower Mobilization Plan

OPNAV INST 3100.6 Series

Special Incident Reporting (OPREP-3) Procedures

OPNAV INST 3120.32 Series

Standard Organization and Regulations of the U.S. Navy

OPNAV INST C 3501.2 Series

Naval Warfare Mission Areas and Required Operational Capability / Projected Operational Environment Statement

OPNAV INST C 3501.161 Series

Projected Operational Environment (POE) and Required Operational Capabilities (ROC) for the T-AH 19 Class Hospital Ship

OPNAV INST C 3501.176 Series

Projected Operational Environment (POE) and Required Operational Capabilities (ROC) for the Combat and Communications Zone Fleet Hospitals and Rapidly Deployable Medical Facility (RDMF)

OPNAV INST 4630.9 Series

World Wide Aeromedical Evacuation

OPNAV INST 5430.48 Series

Office of the Chief of Naval Operations (OPNAV) Organization Manual

OPNAV INST 6000.1 Series

Management of Pregnant Servicewomen


Navy Blood Program

OPNAV PUB 41P3 Series

Table of Advance Base Functional Components with Abridged Initial Outfitting Lists

SECNAV INST 1300.13 Series

Navy Personnel Augmentation for the Fleet Marine Force (FMF)

SECNAV INST 6600.1 Series

Preventive Dentistry Program


Principles of Medical Policy in the Management of a Mass Casualty Situation

T-AH 19 Class Hospital Ship

General Information Manual


(NAVMED P-6530 (1/98) & NWP4-02, App. K, edited superset)

Frozen Blood Capabilities:










































Fleet Hospital

(no frozen blood)




Fluid and Blood Product Availability:

  1. Echelon I: Ringers Lactate and human albumin

  2. Echelon II: Ringers Lactate, human albumin, Group O red blood cells, liquid

3. Echelon III: Ringers Lactate, albumin (25 percent), red blood cells (liquid and frozen), fresh frozen plasma, platelet concentrate

4. Echelon IV: Ringers Lactate, albumin (25 percent), red blood cells (liquid and frozen), fresh frozen plasma, platelet concentrate

  1. Echelon V: Full range of resuscitation fluid and blood products

Planning Factors and Issues: (DoD INST 6480.4)

  • Four units of red blood cells per initial admission of each WIA and DNBI.

  • One technician and two cell washers can deglycerolize 48 units of frozen blood cells in 24 hours. Assign staff for 12-hour shifts and 7-day work weeks.

  • There is NO FROZEN BLOOD RESUPPLY TO SHIPS. Once frozen red cells are used by the LHDs, LHAs, and T-AHs, expect no additional frozen blood from the blood product depots (BPDs). Frozen blood is a transition into liquid blood; count on it for the first few days until the liquid blood pipeline is established. Hence, the early establishment of the pipeline of BSUs, BTCs, AJBPO, and JBPO is imperative.

  • Walking Blood Bank: This is a tertiary source of blood (i.e., to be used only after liquid and frozen blood sources have been depleted (CNSL/P 6000.1 series). However, walking blood bank response should be checked frequently. Activate the Walking Blood Bank (or parts of it) during mass-casualty drills.

  • EXTREMELY IMPORTANT: Meet OPNAV 6530.4A requirements: Save the donor card, a frozen plasma sample, and the correct donor / unit numbers. Report transfusions on ships to BUMED (code 273) for subsequent tracking in the future. This is a BIG ISSUE now, especially with HIV, HTLV, and hepatitis C.

  • Prior to deployment, acquire all message “go-bys” for bringing blood to the ship if needed (a task for the senior advanced lab tech).

AABB American Association of Blood Banks

AJBPO Area Joint Program Office (see JBPO, below), Component Command level.

ASBBC Armed Services Blood Bank Center. An armed service staffed blood bank with a Service assigned as executive agent, responsible for the collection, processing, and storage of blood products. The ASBBC provides blood products for medical treatment elements of two or more of the armed services.

ASBP Armed Services Blood Program

ASBPO Armed Services Blood Program Office

Tri-service staffed, joint field operating Agency, with Army as DoD Executive Agent. CONUS based. The overall DoD manager for blood and BP (class VIIIB) during military contingencies and, when directed, for civilian relief efforts.

ASWBPL Armed Services Whole Blood Processing Laboratory. Tri-service with USAF as Executive Agent. Shipment from CONUS blood banks to Unified Combat Command BTCs or TBTCs.

BDC Blood Donor Center. Component staffed. Requires FDA license.

BP Blood Products

BSU Blood Supply Unit. Component staffed. Receives BPs from BTCs and/or TBTCs or BPDs; issues those products to MTFs in assigned area.

BTC Blood Transshipment Center. USAF staffed. Middle man responsible to receiving, storing, re-icing, and shipping blood. See also TBTC (Transportable Blood Transshipment Center)

BPD Blood Product Depot. Component staffed. Strategic storage of frozen BP in a Unified Combatant Command. DoD Blood Program equivalent to Pre-Positioned Force.

JBPO Joint Blood Program Office. Tri-service staffed, overall joint BP management for Unified Combatant Commander. (cf: SBPO)

SBPO Service Blood Program Office. Component staffed, Coordination and management of that Service’s Blood Program.

TBTC See BTC above. USAF. Transportable to locations with minimal infrastructure.
Blood Support Activities
Blood Resources Management and Support

Joint Blood Program Office - Each unified command has been requested by the Armed Services Blood Program Office to designate a joint health office to implement DoD blood program policies and coordinate the blood programs of the unified command components. The JBPO will be the single interface with the Armed Services Blood Program Office in CONUS. Normally, the JBPO will collocate with the Theater Patient Movement Requirement Center (TPMRC). The JBPO will redistribute blood among regions in the theater and will request blood supply from CONUS. The JPBO will submit a daily blood situation report to the Armed Services Blood Program Office during the contingency using the appropriate format (Annex A). Information copies will be provided to each AJBPO and other agencies as required.
Area Joint Blood Program Office - Unified commands have been requested by the Armed Services Blood Program Office to establish AJPBOs as required. They will implement the unified command blood program policies, coordinate the blood programs of the unified command components within their area, and manage blood products in the assigned BTC. Normally, the AJPBO will collocate with the Area TPMRC. The AJPBO will redistribute blood among components in the theater or request blood supply from the JBPO. The AJBPO will submit a daily blood situation report to the JPBO using the appropriate format (Annex A). Information copies will be provided to each component blood products depot unit and other agencies as appropriate.
Blood Transshipment Centers - The USAF operates the BTCs. The USAF is planning to staff and equip these centers to store and issue up to 3,000 units each of liquid and frozen blood products on a daily basis. Determining the numbers and locations of the centers is a responsibility of the unified command and will be adequate to support each unified command component’s blood requirements on an area basis. Normally, the Navy or Marine Corps will arrange transportation to obtain blood from the BTC for Navy or Marine Corps units. Blood issue to the Navy and Marine Corps will be based on a daily allocation system established by the theater JMBO. The allocations will be modified as required.
Frozen Blood Depots - The Navy operates one frozen blood depot in Sigonella, Sicily, and one in Okinawa, Japan. These depots have the capability to store 40,000 and 10,000 units of frozen blood, respectively. Each depot has one Medical Service Corps officer, Naval Officer Billet Code 0866; one enlisted technician, Navy Enlisted Classification 8506; and four civilian technicians, GS-644-04/05. These depots will provide frozen blood products to appropriate medical platforms upon direction by the AJBPO. The Army is also planning to establish frozen blood depots to store a total of 75,000 units of frozen blood products. The USAF is planning to store 50,000 units of frozen blood in Armed Services Whole Blood Processing Laboratories in CONUS.
Blood Supply Units - The Navy and Marine Corps will establish BSUs as recommended by the JBPOs. Personnel at these supply points will, upon direction by the AJBPO, arrange or provide transportation for blood products from the BTCs to the BSUs and then coordinate shipment to Navy or Marine Corps field medical units, Fleet Hospitals, and ships. The following units are likely to function as BSUs:

  1. Frozen blood depots.

  2. USMC units where medical personnel are responsible for coordinating blood and clinical fluids support.

  3. FSSG detachments in the theater of operations.

  4. Blood donor centers at Naples, Italy; Rota, Spain; and in the United Kingdom.

Medical Field Refrigerator - A lightweight, refrigerated blood box (NSN 410-01-287-7111) operating from direct or alternating current, containing 30 to 50 units of red blood cells. It has been shipped to the field medical supply activities by the Defense Personnel Support Center.
Frozen Blood Container - The USAF developed a shipping and storage container for frozen blood products to transport them without dry ice. It can be ordered through the local medical stock. The stock number is 814013571551 on the Management Data Listing.
Blood Box Management - Whenever possible, blood will be transported from blood supply points in boxes provided by the intended recipient. When the recipient has no box, attempt will be made to return boxes used to ship blood to the blood supply point or to exchange empty for full boxes.
Frozen Blood Management - Assure that Standard Operating Procedure (SOP) is clear on the new USAF frozen blood container and explains the proper handling of the eutectic solutions. To reuse the solutions, they must be COMPLETELY thawed to room temperature and then refrozen at –65C or lower.
Communications - All blood reports and blood shipment reports are sent using standard Armed Services Blood Program Office voice, message, and/or computer-generated blood report formats. The US Message Text Format is the basis for voice and message blood reports. The Armed Services Blood Program Office plans to have the Defense Systems Support Command automate the ASBP blood banks by developing the Defense Blood Standard System. The Theater Army Medical Management Information System has been designated to automate Army activities in the theater and modernized to support the Navy Fleet Hospitals as the Fleet Hospital blood bank module. Any computer systems purchased for CONUS blood collection stations will be compatible with the Defense Blood Standard System, and computer systems purchased for OCONUS MTFs shall be compatible with the Theater Army Medical Management Information System. The Armed Services Blood Program Office requires that the Theater Army Medical Management Information System and the Defense Blood Standard System also be compatible.
Walking Blood Bank - SOP will be clear that blood from walking donors is collected properly. OPNAV instruction require completion of donor cards, saving of frozen blood samples, and correct donor / unit numbers to identify the donor card, donor frozen sample, and unit number. This allows the donated units to be tested and “look-back” for HIV, HCV, etc., to be accurately accomplished.
Pre-qualifying walking donors in CONUS military blood banks just prior to deployment is a method used by some deploying units. However, regardless of pre-qualification, SOP must be followed for each donated unit.

Echelon I, Unit Corpsman and Battalion Aid Station

Resuscitation fluids: Ringers Lactate, human albumin.

Blood / blood products: None.

Echelon II, Shock-trauma Platoons

Resuscitation fluids: Ringers Lactate, human albumin.

Blood / blood products: Frozen blood, Group O liquid blood

Echelon II, Surgical Company

Resuscitation fluids: Ringers Lactate, human albumin .

Blood / blood products: Liquid / frozen blood, fresh frozen plasma, platelet concentrate.
Operational Aspects - The CATF Surgeon or CLF Surgeon will assess blood resources / requirements daily and report to the AJBPO. The CATF Surgeon will coordinate blood and fluid support for the medical battalion from the CRTS, using medical field refrigerators and standard blood boxes. When the CRTSs leave the amphibious ops area, the medical battalion must rely on the medical logistics company or the AJBPO for blood. If no liquid blood is available, blood may be harvested from LF personnel or from the ship’s crew (before leaving the amphibious ops area).
Shock-Trauma Platoon - Each STP can draw 240 units of blood and can process and crossmatch 1,000 units. Each STP can store 120 units in field refrigerators. Occasionally, a STP may be augmented with a surgical support platoon, which has a blood bank capacity equivalent to that of a STP.
Amphibious Assault - Personnel responsible for management of clinical fluids and blood products will report to the CATF Surgeon or LF Surgeon daily. Consider locating a clinical fluids squad with the Surgical company and a clinical fluids platoon with the Medical Logistics Company. These squads can thaw and wash frozen blood and receive and distribute liquid blood. Submit daily blood reports to the AJBPO. The CRTS will supply thawed and washed using standard blood boxes and medical field refrigerators. Frozen blood will be transported in the new shipping and storage containers for frozen blood. Prior to the CRTS leaving the amphibious ops area, or the blood supply aboard the CRTS being depleted, the CLF Surgeon will request more blood / blood products from the AJBPO.
Surgical Company - If liquid or frozen blood is unavailable or unobtainable, each Surgical Company has the capability to draw 720 units and process and cross-match 3,000 units. Storage capability in current field refrigerators is 360 units.
Organizational Aspects - Resuscitation fluids and blood products transported ashore will be handled by the STP, the evacuation platoon at the Beach Evacuation Station, the helicopter support team evacuation station, and medical personnel charged with coordinating blood / clinical fluids for the Surgical or Medical Logistics Company. The CLF Surgeon or representative will manage blood resources and requirements. If frozen blood is needed on the beachhead, deglycerolize it on the LHA / LHD, then ship it ashore.
Transportation - Resuscitation fluids and blood products will be transported ashore primarily by helicopters dispatched to evacuate casualties. A secondary means is ground vehicle landing craft or amphibious landing craft. Transport of resuscitation fluids forward to regimental and BASs will be by any means available, depending heavily on vehicles used for medical evacuation. Additional delivery methods - Navy emergency air cargo delivery systems, low-altitude parachute extraction systems, and high-speed low-altitude - have been successfully tested and may be available. Blood products requested from and assigned by the AJBPO can be picked up or delivered by helicopter from the nearest BSU or BTC assigned by the AJBPO.

Echelon II

Resuscitation Fluids: Ringers Lactate, human albumin

Blood / Blood products: Frozen / Liquid
Operational Aspects

Larger ships and CRTSs will possess the capability to process frozen blood products stored aboard those and other ships within the Task Force. For resupply, ships will contact the TF medical officer who will subsequently contact the AJBPO as needed. It is very important to identify blood resupply points during this communication. Smaller ships will rely on the larger ships and CRTS for blood support. Use the walking blood bank as a tertiary blood source when neither liquid red blood cells nor thawed and washed cells are available. Liquid blood will be transported to other ships in standard blood boxes with 14 lbs. of wet glistening ice or in medical field refrigerators. Frozen blood will be transported in the new shipping / storage container.

One technician with two cell washers can deglycerolize 48 units of frozen red blood cells in 24 hours, staffing based on 12-hour / 7-day work week. Blood aboard ship will be managed by embarked medical personnel and transported by supply and logistics personnel. The Task Force medical officer will manage blood resources and requirements.

Blood can be transported between ships by helicopter or high-line. Resupply of frozen or liquid blood from nearby blood supply points can be transported by helicopter. If distances are prohibitive, blood can be delivered by Navy emergency air cargo delivery system.


(Do Not Leave Homeport Without It)

LT Youssef H. Aboul-Enein, MSC, USNR

Mr. Jeffrey Stiech, BUMED 14

Every fiscal year BUMED-14 issues a message, Subj: FYXX CENTRALLY MANAGED ALLOTMENTS. This message contains accounting data that can be used for foreign hospitalizations, ambulance services, ancillary and non-medical attendant fees FOR ACTIVE DUTY ONLY. Use this message to pay all your foreign medical bills. The only requirement is that upon the completion of care you forward all copies of paperwork, medical records, and invoices to BUMED-14 (currently Mr. Jeff Stiech MED 14L, DSN 762-3577). This is important as it facilitates payment when the bill reaches DFAS (Defense Finance Accounting Service) and avoids embarrassment for your command.

Two additional POCs are Dwight Daniels, (202) 762-3565, DSN 762-3565, and Perwez Hashmi, (202) 762-3578, DSN 762-3578.
Attention MRCOs: you may want to call Mr. Stiech to make sure your unit is an info addee to this valuable message.


(NWP4-02, Section 5, edited subset)

Amphibious Task Force CRTSs

After troops debark for ship-to-shore movement, specific ships of the ATF are designated as primary CRTSs to provide Echelon II HSS to the landing force during amphibious operations. Primary CRTSs have laboratory (including blood) and radiology capability to support surgical suites. During amphibious ops, primary CRTSs are staffed as necessary to provide extensive trauma support. The ships normally designated as the primary CRTSs are the LHA, and LHD class amphibious assault ships.

The CATF may designate amphibious ships as secondary CRTSs. These may include any class ship with the capability to receive and treat casualties, if appropriate medical materiel and personnel are available to provide resuscitative care. Ships normally designated as secondary CRTSs include LPD, LSD, LKA, LST, and LCC class ships.

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